Provider Demographics
NPI:1609281963
Name:MANLEY, SHELBY ELIZABETH
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:MANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W MOANA LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4775
Mailing Address - Country:US
Mailing Address - Phone:775-338-7771
Mailing Address - Fax:
Practice Address - Street 1:1101 W MOANA LN
Practice Address - Street 2:SUITE 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4775
Practice Address - Country:US
Practice Address - Phone:775-338-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health